Volume 22, 2016

Issue 31– Incontinence Supply Criteria
We want to let you know that, effective September 1, 2016, Medicaid has established minimum quality standards for adult- and youth-size diapers and incontinence products.
Issue 30– Drug Therapy Guideline Updates Now Available on Our Website
We want to let you know about our updated drug therapy guidelines.
Issue 29 – Patient-Centered Medical Home Reminder
We want to remind you about our notification process regarding changes in National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition status.
Issue 28 – Change in Laboratory Participation Status
We want to let you know that certain clinical laboratories will no longer be participating with BlueCross BlueShield of Western New York.
Issue 27 – 2015 Pay for Performance Summary
We want to let you know that the 2015 Pay for Performance (P4P) incentive payments have been mailed and summary reports are now available on our secure provider website.
Issue 26 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 25 – Notice of New Annual Regulatory Audit
We want to let you know that, as a result of the Accountable Care Act, individual and small group products—both on- and off-exchange—are now risk-adjusted.
Issue 24 – Changes to Hepatitis C Drug Therapy Guidelines
We want to let you know about an update to our hepatitis C drug therapy guidelines.
Issue 23 – Reminder: Billing for Out-of-Area Medicaid
We want to remind you about some important details when billing for out-of-area Medicaid patients.
Issue 22 – BestPractice Capitated Code List
We want to let you know that the BestPractice capitated code list is now available
Issue 21 – Revised Anesthesia Billing Update
We want to let you know about changes to billing for anesthesia services.
Issue 20 – Diabetic Eye Exam Reminder
We want to let you know about efforts underway to improve communication between providers caring for the same patient. The goal is to improve quality and continuity of care.
Issue 19 – Drug Therapy Guideline Updates Available on our Website
We want to let you know about drug therapy guidelines that will take effect June 15, 2016.
Issue 18 – Hospital-based Providers Enrollment Update
Certain hospital-based providers, while not subject to credentialing, needed to register with us in order to participate in the BlueCross BlueShield of Western New York network.
Issue 17 – Performance and Quality Program Reminder
We want to remind you about our 2016 physician performance and quality initiative.
Issue 16 – Anesthesia Billing Update
We want to let you know about changes for billing anesthesia services.
Issue 15 – Revised CMS-1500 Claim Form (2/12): Final Notice
We want to remind you that, effective May 1, 2016, we are no longer accepting the CMS-1500 claim form (8/05). Incomplete, invalid, and/or incorrect claims will be returned.
Issue 14 – No Preauthorization Required for Trigger Point Injections
As a follow up to our January 15 stat bulletin about the Palladian Health Spine Pain Management Program, we want to clarify that trigger point injections do not require preauthorization.
Issue 13 – BlueCross BlueShield of Western New York 2016 Dental Fee Schedule Update
We listened to your feedback and are pleased to announce that we will soon be releasing an updated dental fee schedule.
Issue 12 – Reimbursement Changes: Medical Injectables
We want to let you know about the corporate medical injectable fee schedule changes, which take effect on July 1, 2016.
Issue 11 – 2016 Fee Schedule Announced
We want to let you know that BlueCross BlueShield of Western New York will issue updated Standard Commercial and Medicare Advantage Fee Schedules that will take effect July 1, 2016.
Issue 10 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 9 – Reimbursement and Billing for Out-of-Area Medicaid
We want to remind you that identification (ID) cards for BlueCross BlueShield plans do not always indicate that the patient has Medicaid coverage.
Issue 8 – Drug Therapy Guideline Updates
We want to let you know about drug therapy guidelines that will take effect March 15, 2016.
Issue 7 – Fee Schedule/Performance and Quality Program Reminder
We want to remind you about the additional incentives that you can earn in 2016 through our Annual Wellness Visit (AWV) Initiative Program.
Issue 6 – Changes to our Performance and Quality Programs
We want to let you know about our 2016 physician performance and quality initiatives.
Issue 5 – Revised CMS-1500 Claim Form (2/12)
As a reminder, the revised CMS-1500 claim form (2/12) was implemented April 1, 2014. Effective May 1, 2016, the CMS-1500 claim form (8/05) will no longer be accepted. Incomplete, invalid, and/or incorrect claims will be returned.
Issue 4 – Medication Therapy Management Program
The Centers for Medicare & Medicaid Services (CMS) requires that each Medicare Part D plan provide a Medication Therapy Management (MTM) program benefit.
Issue 3 – Spinal Procedure Preauthorizations through Palladian Health
We want to let you know that, effective April 15, 2016, preauthorizations for inpatient and outpatient spinal procedures will be managed through Palladian Health®.
Issue 2 – Billing Guidelines for Health Reimbursement Accounts
We want to make it as simple as possible for you to provide services to Wyoming County employees enrolled in the BlueCross BlueShield of Western New York PPO 8000 medical plan with a health reimbursement account (HRA).
Issue 1 – Blue ConsumerTransparency Physician Quality Measures
As part of our ongoing collaboration with health care providers and the BlueCross BlueShield Association (BCBSA) to provide information and tools to help patients make informed health care decisions, your consumer transparency physician quality measures are now available for review.